Polycystic ovarian syndrome (PCOS)
Polycystic ovarian syndrome (Stein-Leventhal syndrome) involves enlarged ovaries, which contain many fluid-filled sacs (cysts), and a tendency to have high levels of male hormones (androgens).
- Polycystic ovarian syndrome (PCOS) affects about 7 to 10% of women.
- A common cause is the excess production of luteinizing hormone by the pituitary gland.
- The excess luteinizing hormone increases the production of male hormones (androgens).
- If the disorder is not treated, some of the male hormones may be converted to estrogens.
- Not enough progesterone is produced to balance the estrogens’ effects.
- If this situation continues for a long time, the lining of the uterus may become extremely thickened.
- Also, the risk of the cancer of the lining of the uterus may be increased.
- Symptoms typically develop during puberty.
- In some women, menstrual periods do not start at puberty.
- Thus, these women do not release an egg from the ovaries.
- These women also develop symptoms related to high levels of male hormones – a process known as masculinization or virilization.
- Symptoms include acne, deepened voice, reduction in breast size, increase in muscle size, and increase in body hair in male pattern such as on chest and on the face.
- Many women with polycystic ovarian syndrome produce too much insulin or insulin they produce does not function properly.
- Consequently, these women tend to gain weight or have a hard time losing weight.
- Most women with the polycystic ovarian syndrome are obese.
- Other women have irregular vaginal bleeding with no increase in weight or body hair.
- Women with the polycystic ovarian syndrome also have an increased risk of heart disease, diabetes and high blood pressure.
- The diagnosis is based on the symptoms.
- Blood tests to measure the levels of luteinizing hormone and male hormones are performed.
- Ultrasound scan of the ovaries may be performed.
- An ultrasound scan or computed tomography scan may be used to determine whether the male hormones are being produced by an ovarian tumor or by the adrenal gland.
- No ideal treatment is available.
- The choice of the treatment depends on the type and severity of symptoms, the woman’s age and her plans regarding pregnancy.
- Often a biopsy of the uterine lining is performed to make sure no cancer is present.
- If insulin levels are high, lowering them may help.
- Exercising at least 30 minutes a day may help.
- Reducing the intake of carbohydrate-rich foods like bread, pasta, potatoes and sweets can help lower insulin levels.
- In some women, weight loss lowers insulin levels enough that ovulation can begin.
- Weight loss may help reduce the hair growth and the risk of thickening of the uterine lining.
- Women who do not wish to become pregnant may take progestin by mouth or a combination oral contraceptive containing estrogen and progestin.
- Either treatment may reduce the risk of cancer of the uterine lining due to high estrogen level and help lower the levels of male hormones.
- However, oral contraceptives are not given to women who have reached menopause or who have other significant risk factors for heart disease or blood vessel disorder.
- Women who wish to become pregnant may take clomiphene.
- This drug stimulates ovulation.
- If clomiphene is not effective, other hormones may be tried.
- These include follicle stimulating hormone – to stimulate the ovaries, gonadotropin-releasing hormone agonist – to stimulate the release of follicle stimulating hormone and human chorionic gonadotrophin – to trigger ovulation.
- Increased body hair may be bleached or removed by electrolysis, plucking, waxing, hair removing liquids or creams or laser.
- No drug treatment for removing excess hair is ideal or completely effective.
- Oral contraceptives may be effective, but they must be taken for several months before any effects are seen, which is often slight.
- Spironolactone – a drug which blocks the production and action of male hormones can be used to remove unwanted body hairs. Side effects include urine production and low blood pressure.
- Spironolactone may not be safe for developing fetus. So sexually active women taking the drug are advised to use birth control methods.
- Cyproterone, a strong progestin that blocks the action of male hormones, reduces unwanted body hair in 50 to 75% of affected women.
- It is used in many countries but it is not approved in the United States.
- Gonadotropin-releasing hormone agonist and antagonist are being studied as the treatment for unwanted body hair.
- Both types of drugs inhibit the production of sex hormones by the ovaries.
- But both can cause bone loss and lead to osteoporosis.
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